Basic Information
| Provider Information | |||||||||
| NPI: | 1467571513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT REHABILITATION ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 E 2ND AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094556002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 407 E 2ND AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094556002 | ||||||||
| FaxNumber: | 5097475990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOCTOR | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5094556002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L, ATP, CEES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7682131 | 05 | WA | MEDICAID | 7087216 | 05 | WA | MEDICAID | 115084 | 01 | WA | LABOR & INDUSTRIES | OTHER |